Epilepsy surgery near or in eloquent cortex in children—Practice patterns and recommendations for minimizing and reporting deficits

Jayakar, Prasanna; Jayakar, Anuj; Libenson, Mark H.; Arzimanoglou, Alexis; Rydenhag, Bertil; Cross, J. Helen; Bhatia, Sanjiv; Tassi, Laura; Lachhwani, Deepak; Gaillard, William D.

doi:10.1111/epi.14510

Cited by 23 publications

(17 citation statements)

References 40 publications

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“…[10][11][12][14][15] Furthermore, large-scale studies in adults and more diverse populations (pediatric patients and patients with epilepsy) are not feasible because of continued decline in the use of invasive techniques. Many epilepsy and neurosurgery centers now rely on functional magnetic resonance imaging (MRI) for presurgical language mapping [16][17][18] because it has been validated against invasive methods. [19][20][21] This widespread use of functional MRI allows for a broader verification of TMS-determined language maps in a diverse patient population.…”

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confidence: 99%

Concordance Between Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (MRI) Derived Localization of Language in a Clinical Cohort

et al. 2020

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Transcranial magnetic stimulation (TMS) is a newer noninvasive language mapping tool that is safe and well-tolerated by children. We examined the accuracy of TMS-derived language maps in a clinical cohort by comparing it against functional magnetic resonance imaging (MRI)–derived language map. The number of TMS-induced speech disruptions and the volume of activation during functional MRI tasks were localized to Brodmann areas for each modality in 40 patients with epilepsy or brain tumor. We examined the concordance between TMS- and functional MRI–derived language maps by deriving statistical performance metrics for TMS including sensitivity, specificity, accuracy, and diagnostic odds ratio. Brodmann areas 6, 44, and 9 in the frontal lobe and 22 and 40 in the temporal lobe were the most commonly identified language areas by both modalities. Overall accuracy of TMS compared to functional MRI in localizing language cortex was 71%, with a diagnostic odds ratio of 1.27 and higher sensitivity when identifying left hemisphere regions. TMS was more accurate in determining the dominant hemisphere for language with a diagnostic odds ratio of 6. This study is the first to examine the accuracy of the whole brain language map derived by TMS in the largest cohort examined to date. While this comparison against functional MRI confirmed that TMS reliably localizes cortical areas that are not essential for speech function, it demonstrated only slight concordance between TMS- and functional MRI–derived language areas. That the localization of specific language cortices by TMS demonstrated low accuracy reveals a potential need to use concordant tasks between the modalities and other avenues for further optimization of TMS parameters.

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confidence: 99%

Concordance Between Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (MRI) Derived Localization of Language in a Clinical Cohort

et al. 2020

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“…• Patients with diffuse or bilateral ictal scalp EEG had a higher probability of disclosing an intralesional or perilesional activation during WG task than patients with focal ipsilateral ictal scalp EEG (OR = 12.83, p = 0.031, LR χ 2 (1) = 6.51 p = 0.011, Pseudo R 2 = 0.19 and OR = 6.27, p = 0.05, LR χ 2 (1) = 4.47 p = 0.034, Pseudo R 2 = 0.09, respectively).…”

Section: Plos Onementioning

confidence: 98%

“…Regression models showed that LI during comprehension task became more atypical when age at seizure onset increased (regr. coeff = -0.051; p = 0.036, LR χ 2 (1) = 4.93 p = 0.026, Adj R 2 = 0.15) and if patients were left-handed (regr. coeff = -0.6; p = 0.020, LR χ 2 (1) = 6.02 p = 0.014, Adj R 2 = 0.19).…”

Section: Plos Onementioning

confidence: 99%

“…Patients with drug-resistant epilepsy may benefit from surgical treatment with rates of seizure freedom ranging from 36% to 84% [1]. When seizures arise from, or in close proximity to, eloquent cortical areas, precise preoperative functional mapping is needed to seek complete resection of the seizure onset zone (SOZ), thus increasing the chances for seizure freedom and minimizing the risk for postoperative deficits [2]. However, mapping brain functions using either functional or structural networks can be challenging, especially for language assessment.…”

Section: Introductionmentioning

confidence: 99%

“…The boundaries and lateralization of language areas may vary depending on the patient’s language skills, the analysis parameters used, the task and control conditions and the eloquent areas to be identified [ 5 ]. Cortical mapping is especially challenging in children [ 5 , 6 ], due to limited cooperation and movement artefacts, forcing the different centers to adopt variable strategies [ 2 ]. A few fMRI studies have suggested that results obtained in children and adolescents may appear similar to those observed in adults [ 4 , 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Patterns and predictors of language representation and the influence of epilepsy surgery on language reorganization in children and young adults with focal lesional epilepsy

et al. 2020

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Mapping brain functions is crucial for neurosurgical planning in patients with drug-resistant seizures. However, presurgical language mapping using either functional or structural networks can be challenging, especially in children. In fact, most of the evidence on this topic derives from cross-sectional or retrospective studies in adults submitted to anterior temporal lobectomy. In this prospective study, we used fMRI and DTI to explore patterns of language representation, their predictors and impact on cognitive performances in 29 children and young adults (mean age at surgery: 14.6 ± 4.5 years) with focal lesional epilepsy. In 20 of them, we also assessed the influence of epilepsy surgery on language lateralization. All patients were consecutively enrolled at a single epilepsy surgery center between 2009 and 2015 and assessed with preoperative structural and functional 3T brain MRI during three language tasks: Word Generation (WG), Rhyme Generation (RG) and a comprehension task. We also acquired DTI data on arcuate fasciculus in 24 patients. We first assessed patterns of language representation (relationship of activations with the epileptogenic lesion and Laterality Index (LI)) and then hypothesized a causal model to test whether selected clinical variables would influence the patterns of language representation and the ensuing impact of the latter on cognitive performances. Twenty out of 29 patients also underwent postoperative language fMRI. We analyzed possible changes of fMRI and DTI LIs and their clinical predictors. Preoperatively, we found atypical language lateralization in four patients

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Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study

Barba,

Pelliccia,

Grisotto

et al. 2024

Epilepsia Open

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ObjectiveTo assess seizure and developmental outcomes, their predictors, and complications in 160 children who, between 1998 and 2022, underwent surgery for lesional epilepsy with curative intent before the age of 3 years. To compare trends in epilepsy surgery in this age group before and after the year 2014.MethodsRetrospective multicenter study. Descriptive and univariate analyses, and multivariable models for all outcomes.ResultsThese 160 patients (76 F; 47.5%) underwent 169 surgeries (age at surgery 20.4 ± 9.4 months). At the last follow‐up (77 ± 57.4 months), 121 patients (75.6%) were in Engel class I, 106 (66.2%) of whom were in Engel class Ia. Antiseizure medications were stopped in 84 patients (52.5%). Complications requiring reoperations were observed in 16 patients (10%; 9.5% of surgeries) and unexpected permanent deficits in 12 (7.5%; 7.1% of surgeries). Postoperative cognitive functions remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Multivariable analyses showed that the probability of achieving Engel class Ia was lower when the duration of epilepsy was longer, patients underwent preoperative video‐EEG, and unexpected postoperative permanent deficits occurred. Cognitive improvement after surgery was associated with lower preoperative seizure frequency, better preoperative developmental level, and a longer postoperative follow‐up. FCDII and tumors were the histopathologies carrying a higher probability of achieving seizure freedom, while polymicrogyria was associated with a lower probability of cognitive improvement. The number of patients operated on after 2014 was higher than before (61.3% vs. 38.7%), with stable outcomes.SignificanceEpilepsy surgery is effective and safe in infants and toddlers, although the complication rate is higher than seen in older patients. Shorter duration of epilepsy, lower seizure frequency, no need for video‐EEG, tumors, and some malformations of cortical development are robust predictors of seizure and cognitive outcome that may be exploited to increase earlier referral.Plain Language SummaryThis study analyzed the results of epilepsy surgery in 160 children who had been operated on before the age of 3 years at four Italian centers between 1998 and 2022. At the last follow‐up (77 ± 57.4 months), 121 patients (75.6%) were free from disabling seizures, of which 106 (66.2%) were completely seizure‐free since surgery. Major surgical complications occurred in 28 patients (17.5%), which is higher than observed with epilepsy surgery in general, but similar to hemispheric/multilobar surgery. Postoperative cognitive function remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Epilepsy surgery is effective and safe in infants and toddlers.

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Epilepsy surgery near or in eloquent cortex in children—Practice patterns and recommendations for minimizing and reporting deficits

Cited by 23 publications

References 40 publications

Concordance Between Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (MRI) Derived Localization of Language in a Clinical Cohort

Concordance Between Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (MRI) Derived Localization of Language in a Clinical Cohort

Patterns and predictors of language representation and the influence of epilepsy surgery on language reorganization in children and young adults with focal lesional epilepsy

Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study

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